Age-Related Cognitive Decline in Physicians: Evaluation and Intervention

Many of us have aging family members and friends who suffer from cognitive impairment and its impact on memory, language, thinking and judgment.

The American Academy of Neurology estimates that mild impairment is present in about 8% of people age 65 to 69 and in 15% of 75- to 79-year-olds. And current research indicates that for many people, mild cognitive impairment precedes the development of full-blown dementia.¹

No group is immune from cognitive decline, not even physicians. However, given their responsibility for the care of others, such impairment can create serious issues.

Physicians who are impaired due to age-related cognitive decline are less likely to adhere to the appropriate standards of care and are more likely to have an increase in poor patient outcomes. Allowing impaired physicians to continue their medical practice can compromise patient safety and the integrity of the medical profession.

That’s why, if a physician believes a colleague may be impaired due to cognitive decline, it’s important to evaluate the situation and intervene in a timely manner, even though recognizing impairment and confronting a colleague about it can be difficult. MagMutual has developed the following information to help.

Recognizing Impairment

According to the American Medical Association,² an impaired physician is one who has a physical or mental health condition that interferes with the ability to engage safely in professional activities. In the case of cognitive decline, a physician is less likely to follow standards of care, less likely to consider and adopt new therapies, and may have poorer patient outcomes. As a result, the physician compromises professional relationships, puts patients at risk and undermines trust in medicine. 

Little guidance exists on identifying impaired physicians before an adverse event. Sometimes the warning signs are obvious:

• Increased patient complaints 
• Poor patient outcomes
• Decreased quality of care and careless medical decisions
• Increased irritability or forgetfulness 
• Decreased productivity or efficiency
• Depression, anxiety and mood instability.

The Federation of State Medical Boards’ Policy on Physician Illness and Impairment³ is an excellent resource for identifying a potentially impaired physician and guiding rehabilitation. 

However, all too often, signs of cognitive impairment aren’t clear. In those cases, the physician should be referred to a third party who is trained and credentialed to evaluate and confirm impairment. 

When Should You Intervene?

Some impaired physicians may be reluctant to seek help or admit their impairment because they fear the potential consequences. If a physician denies cognitive impairment or is unwilling to discuss their mental or physical health, a more formal intervention with other medical professionals may be required to help the physician recognize impairment and the risks it poses.

Physicians may not feel comfortable confronting an impaired colleague. In general, there is a duty to respect the autonomy of physicians, and an intervention may feel intrusive. But if there is suspicion about a physician’s mental or physical health, that duty can be waived. Physicians have an ethical and legal duty to report behavior that puts patients at risk. Failure to monitor themselves and their colleagues can compromise their reputation and the medical profession itself. 

AMA Principles of Medical Ethics state that patient well-being must always be the primary consideration. Keeping the ethics guidance and applicable law in mind, physicians should confront and, if necessary, report impaired colleagues in a timely manner.  

The first step in an intervention can be as simple as expressing collegial concern. A genuine “How are you?” can open the door to a more meaningful conversation. Five steps to an effective intervention are:

1. Express concern to the physician.
2. Arrange a meeting with the physician either one-on-one or with other healthcare professionals.
3. If patient safety isn’t at risk, present options such as reducing hours or taking a break from work. If patient safety is a concern even under reduced or restricted practice, recommend that the physician cease practice.
4. If the physician stays in denial, communicate consequences such as the suspension of privileges or being reported.
5. If the physician still refuses to comply, it may be necessary to contact the licensing board.

Patient Safety Is Primary

Physicians who fail to file reports concerning impaired colleagues generally aren’t placing themselves at risk unless reporting is required by a state board. But failing to address an impaired physician means that patients will continue to be at risk for poor outcomes.

After an impaired physician has been identified and confronted, healthcare organizations should make sure the physician modifies their practice, or ceases it altogether, to ensure that quality patient care continues to be provided safely. And to reduce the risk of impaired physicians and compromised patient care on an ongoing basis, organizations should establish mechanisms to promote health and wellness among physicians – a move that will benefit doctors and patients alike.

MagMutual’s Learning Center offers many additional resources concerning the business, practice and regulation of medicine.

1 Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/17990-mild-cognitive-impairment

2 https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/code-of-medical-ethics-chapter-9.pdf

3 https://www.fsmb.org/siteassets/advocacy/policies/policy-on-physician-impairment.pdf

Disclaimer: The information provided in this article does not constitute legal, medical or any other professional advice. No attorney-client relationship is created and you should not act or refrain from acting on the basis of any content included in this article without seeking legal or other professional advice.